Provider Demographics
NPI:1932382462
Name:STOVER FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:STOVER FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILOAH
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-225-9944
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0048
Mailing Address - Country:US
Mailing Address - Phone:580-225-9944
Mailing Address - Fax:580-225-9943
Practice Address - Street 1:1710 W 3RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5159
Practice Address - Country:US
Practice Address - Phone:580-225-9944
Practice Address - Fax:580-225-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1932382462OtherGROUP NPI
OKV07376OtherUPIN
OK1417959883OtherINDIVIDUAL NPI
OK1932382462OtherGROUP NPI
OK300522194Medicare PIN